Advocacy News

February 16, 2016



Senate Health Innovation Bills Approved

Leadership Letter on Pre-Certification Procedures

Obama Administration Budget Proposal

Bonefied News

Telemedicine Legislation Introduced

Members of Congress Express Support for Trauma Care

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AAOS Office of Government Relations (OGR) and our Orthopaedic PAC at the Annual Meeting

AAOS to Participate in Alternative Payment Model Project

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2015 EHR Reporting Participation and Hardship Exemption Information

AdvaMed: Regulatory Update & Proposed Common Rule Changes

AMA Excellence in Medicine Awards Call for Nominees

ASA’s PSH Learning Collaborative 2.0 Seeks Your Participation – Applications Due March 15

AAOS Orthopaedic PAC Online Contribution Center


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AAOS to Participate in Alternative Payment Model Project

As part of the American Association of Orthopaedic Surgeons’ (AAOS) efforts to develop physician-led, orthopaedic procedure-based alternative payment models (APMs) or bundles, AAOS has agreed to participate in a collaborative led by the American College of Surgeons (ACS) in partnership with Brandeis University. The goal of the “The Alternative Payment Model Project” is to provide a framework for an episode-based model for surgical care. The model will be presented to the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare & Medicaid Innovation (CMMI) for consideration under the Medicare Access and CHIP Reauthorization Act (MACRA) as a qualified APM, with an emphasis on performance measurement goals congruent with the CMS Quality Strategy.

The ACS and Brandeis University have been collaborating for over two years to create project methodology which included generating tasks for episode modeling, data collection, and software development. Most importantly, they compiled a list of 95 procedures known as “Brandeis Group APM Targets” or more commonly, the “Brandeis Bundles” for which they possess Medicare claims data for all procedures included in the list. While no precise rationale was provided for the procedures chosen, they were likely included as they were shown to be “high-volume” procedures within the claims data.

In what the ACS is deeming the “initial phase” of project implementation, the group continues to seek specialty society participation and input so that each specialty may “take control” of their particular episodes or bundles and relevant methodology and provide feedback to Brandeis. Subsequent to ACS’ request for each participating specialty society to choose several procedures from the Brandeis list and after soliciting feedback from AAOS volunteer leaders, AAOS prioritized the orthopaedic procedures included in the list. The initial procedures chosen around which to develop episodes of care include: 

  • Rotator cuff repairs;
  • Knee arthroscopies; and
  • Hip fractures.

According to Dr. Alexe Page, Chair of the AAOS Health Care Systems Committee (HCSC), “CMS reimbursement under MACRA strongly favors the APM track over the Merit-based Incentive Payment System (MIPS) track, yet APM participation for specialists is limited.”

“Through bundled payments, orthopaedic surgeons can define the value of a myriad of musculoskeletal procedures and diagnoses,” Dr. Page stated. “AAOS participation in the ACS APM project can broaden the options for our participation in APMs qualified for CMS reimbursement.”

ACS and Brandeis plan to submit project methodologies/results to CMMI in the fall of 2016 for a grant to pilot the project as an APM demonstration.

To this end, Dr. Will Shaffer, AAOS’ Medical Director and several staff members from the Office of Government Relations (OGR), traveled to CMS to meet with Amy Bassano, Director of the Patient Care Models Group within CMMI and several CMMI staff members. Discussions centered on how AAOS can assist CMMI in their efforts to develop bundles and AAOS’ concerns regarding the inclusion of hip fractures in Medicare’s Comprehensive Care for Joint Replacement Payment Model (CJR) demonstration program. While Ms. Bassano and her staff stated hip fractures will remain in the CJR demo for the time being, they are willing to work with AAOS to possibly refine the CJR model to accommodate hip fractures. CMMI will also look to AAOS to provide input regarding the development of hip fracture performance measures. Finally, CMMI staff conveyed their interest in outpatient bundles but stated they have yet to address this area, at which time Dr. Shaffer conveyed AAOS’ willingness to be involved in and perhaps initiate the outpatient bundling process at some point in the future.

AAOS will provide members with ACS project status updates and the results of any additional discussions with CMMI in the coming months.